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Prevalence and Risk Factors of Toxoplasma Gondii Infection Among Pregnant Women in Hormozgan Province, South of Iran

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Prevalence and Risk Factors of Toxoplasma Gondii Infection Among Pregnant Women in Hormozgan Province, South of Iran Iran J Parasitol: Vol. 14, No. 1, Jan-Mar 2019, pp.167-173 Iran J Parasitol Tehran University of Medical Open access Journal at Iranian Society of Parasitology Sciences Public a tion http:// ijpa.tums.ac.ir http://isp.tums.ac.ir http://tums.ac.ir Short Communication Prevalence and Risk Factors of Toxoplasma gondii Infection among Pregnant Women in Hormozgan Province, South of Iran Seyedeh Zahra KHADEMI 1,2, *Fatemeh GHAFFARIFAR 1, Abdolhosein DALIMI 1, Parivash DAVOODIAN 3, Amir ABDOLI 4,5 1. Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran 2. Department of Biology, Payam Noor University, Tehran, Iran 3. Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Ban- dar Abbas, Iran 4. Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran 5. Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran Received 19 Oct 2017 Abstract Accepted 11 Jan 2018 Background: Toxoplasmosis can cause miscarriage or complications in the fetus. Diagnosis and treatment of this disease by anti-parasitic drugs especially in early pregnancy can help to prevent fetal infection and its complications. This study Keywords: aimed to determine T. gondii infection in pregnant women, evaluate risk factors in Toxoplasma gondii; the transmission of the disease and congenital toxoplasmosis. Pregnant women; Methods: Overall, 360 sera of pregnant women from 5 cities in the Hormozgan Prevalence; Province in southern Iran with different climate were evaluated from 2015-2016 Iran for T. gondii infection by using ELISA method and positive cases of IgM and IgG were tested again using Avidity IgG ELISA. All cases were evaluated according to climate, acute and chronic of toxoplasmosis, number of pregnancy and abortion, epidemiological factors and food habits. *Correspondence Results: Among 360 specimens T. gondii IgG + IgM antibodies were found posi- Email: tive in 0. 8% subjects and also 27% of samples had IgG seropositivity. A significant [email protected] relationship was observed between age, sampling place, consumption of raw and half cooked meat, history of contact with cats, abortion history, number of chil- dren, and parity with IgG positive. In Avidity IgG ELISA test, 13 people with low avidity, 3 people with borderline avidity were reported. Conclusion: 72. 2% of the population had no antibody against the disease that this could be a warning to the people and requires education of preventive and prenatal care and routine screening of women at childbearing age. 167 Available at: http://ijpa.tums.ac.ir Khademi et al.: Prevalence and Risk Factors of Toxoplasma gondii Infection … Introduction ongenital toxoplasmosis is an im- is particularly useful in detecting new cases as portant infectious cause of abortion a complementary approach. The primary or C and pregnancy complications world- immature antibodies have low affinity, but wide (1). Toxoplasmosis is influenced by some affinity increases with disease proceed and will factors such as environmental conditions, nutri- stay for weeks and months. Avidity index de- tional and cultural habits, and hygiene. Climate pends on the duration of infection (7). condition can play vital role in oocysts survival. According to a meta-analysis, the overall se- The prevalence of T. gondii infection in hot and roprevalence rates of T. gondii infections is 39. humid climates is higher than warm and dry 9% (95% CI: 26. 1-53. 7) among childbearing areas and is also low in Polar Regions (2). age women in Iran (9). Moreover, two previous "Vertical transmission of T. gondii to the fe- studies in Bandar Abbas (capital of Hormozgan tus occurs predominantly in women who ac- province) showed seroprevalence rates of 49% quire the infection at the first time during (10) and 34% (11) in pregnant women. Since pregnancy "(3). Congenital toxoplasmosis can there is no comprehensive study on the preva- lead to a wide variety of manifestations ac- lence of toxoplasmosis in different cities of cording to gestational age of mothers, while, Hormozgan Province, the present study inves- severe clinical signs are more common in tigates the prevalence of T. gondii infection and women whose infection was acquired during related risk factors in a number of pregnant early gestation (4). In contrast, the risk of ver- women referring to health centers in Hor- tical transmission is increase with the gesta- mozgan Province in southern of Iran. Addi- tional age, so the highest rates of transmission tionally, IgG avidity test was used as occur in the last gestation. At this stage, the complementary test in the women who were infection is usually asymptomatic but may de- positive for IgG and IgM antibodies to T. gondii velop clinical such as neurological disorders and chorioretinitis at a later age (5). The annu- Materials and Methods al incidence of congenital toxoplasmosis was estimated in the world at 190100 cases. Metic- Area of study ulous information on the ''prevalence and risk Hormozgan Province is located in the north factors of infection" with T. gondii are required of the Hormuz Strait in southern Iran and to plan proper "prevention measures" against cover an area of about 70,697 square kilome- infection during pregnancy and congenital ters. This province has a very hot and humid transmission (6). climate (ranging between 30-49 °C and hu- A number of serological methods have been midity of 90%-100% in summers), with an developed to diagnose T. gondii infections (7). average annual rainfall of 180 mm (12,13). However, screening of IgG and IgM antibod- ies by ELISA method is a routine diagnostic Sample size method in clinical laboratories. IgM antibodies The study population was pregnant women appear in the first week of infection and reach who referred to the health centers in Hor- at the maximum level after 3 wk of infection. mozgan Province from 2015-2016. The sam- IgG antibodies usually appear two weeks after ple size was calculated by the following for- infection and reach to a peak within 8 to 10 mula and according to the previous studies in wk of infection. The presence of IgG and Bandar Abbas that reported the seropreva- absence of IgM indicates the history of lence of 38% among pregnant women (10,11). previous infection (7,8). Avidity IgG method Accordingly, 360 serum samples were collect- Available at: http://ijpa.tums.ac.ir 168 Iran J Parasitol: Vol. 14, No. 1, Jan-Mar 2019, pp.167-173 ed from pregnant women from 5 different RAI <40%: indication of low-avidity anti- cities of the province (Bandar Abbas, Minab, bodies. Haji Abad, Bastak, Qeshm) based on geo- RAI 40%-60%: equivocal range. graphic location and climate condition. RAI >60%: indication of high-avidity anti- N=Z2 P (1- P)/d2 Z=1. 96. P=0.38. d=0.05 bodies. Ethical aspects PCR The study protocol was approved by the The final diagnosis of toxoplasmosis in low Ethical Committee of Hormozgan University avidity cases was performed by a 529 bp gene of Medical Sciences Ethical number: (5-HEC- which replicates 200-300 in the T. gondii ge- 94-3020). All participants were informed nome (14). about the study, and sampling was conducted with informed consent. Statistical analysis All data were analyzed by SPSS (ver. 20 Chi- Sample collection cago, IL, USA) using Chi-square, Cross tab Two milliliters of blood from women re- sand Correlate Pearson test. ferred to health centers for routine pregnancy tests were collected, and their sera were stored Results at -20 °C until test. Moreover, information about pregnant women and the risk factors of Serum samples were collected from 360 the infection were gathered by questionnaire pregnant women with a mean age of 27 yr (14- at the time of sampling. Questions focused on 55) who were at different months of pregnan- possible risk factors for infection, including cy. Table 1 shows serological findings of the presence or ownership of animals, eating pregnant women taken from different cities of habits, soil contact, and etc. Hormozgan province. The percentage of T. gondii IgG and IgM+IgG positive antibodies Serological Evaluation were 27. 8% (100/360) and 0. 83% (3/360) Conventional ELISA respectively. Three women were seropositive The presence of anti-Toxoplasma IgM and for both IgG and IgM antibodies (Table 1). IgG antibodies were screened using ELISA Table 2 shows history of abortion according assay, with an ELISA kit (Pishtaz Teb, Tehran, to antibody levels. Accordingly, total IgG se- Iran) according to the manufacturer's protocol. ropositivity was significantly increased in The positive cut-off value of IgG and IgM pregnant women with a history of abortion antibodies was defined as the upper limit of (P=0.01). Risk factors of T. gondii seropositivity the 10 and 1. 1 U/mL, respectively. describe in Table 3. Significant associations were observed between IgG seropositivity and Avidity ELISA number of pregnancies (P=0. 001), age To double check, the results an IgG Avidity (P=0.004), contact to cat (P=0.03), consump- test was conducted on 100 samples with the tion of raw or half-cooked meats (P=0.05) and IgM and IgG anti-Toxoplasma antibodies using raw vegetables consumption (P=0.03) (Table 3). Toxo IgG avidity kit (EUROIMMUN, Ger- many), according to the manufacturer's proto- PCR analysis col. The diagnostic value was defined as rela- T. gondii DNA was detected in all 13 cases re- tive avidity index (RAI). The avidity index was ported low avidity in avidity ELISA method determined as the following criteria: by using 529 base pairs gene. 169 Available at: http://ijpa.tums.ac.ir Khademi et al.: Prevalence and Risk Factors of Toxoplasma gondii Infection … Table 1: T. gondii serological findings in pregnant women in 5 cities of Hormozgan province, southern Iran City Bandar Abbas Minab Haji Abad Bastak Qeshm Total (%) (N=190) (%) (N=40) (%) (N=40) (%) (N=40) (%) (N=50) (%) IgG positive 46(24.
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